title: Alternating Polistes-Vespula venom immunotherapy: a therapeutic strategy to resolve a diagnostic deficiency.
abstract: BACKGROUND
  In Mediterranean regions, double sensitization to Polistes and Vespula species is frequent in patients reacting to an unidentified wasp sting. Since both genera are present, it is often difficult to determine which insect is responsible and, consequently, select venom for immunotherapy. When a specific diagnosis cannot be made, a new therapeutic strategy should be undertaken.
  
  
  METHODS
  We performed a case-control study in which 37 patients who were allergic to venom from Vespula and Polistes species received a 3-year schedule of alternating immunotherapy. Twenty monosensitized patients (10 to Vespula and 10 to Polistes) received conventional venom immunotherapy (VIT) during the same period. All 57 patients received the same number of injections. The effectiveness of VIT was assessed by means of re-sting, which was performed yearly. Serum specific immunoglobulin (Ig) E and IgG4 were also studied,
  
  
  RESULTS
  All the cases tolerated all the stings. One control patient developed a mild systemic reaction after the first-year Vespula sting but tolerated subsequent re-stings. Both cases and controls reached significant changes in levels of IgE and IgG4 after VIT (P < .04 at minimum). The cases developed a response as expected, although this was less intense than in the control group. In the Polistes control subgroup, sIgE to Polistes decreased to under baseline levels, after a marked initial increase; this decrease was not observed in the Vespula subgroup.
  
  
  CONCLUSIONS
  An alternating VIT strategy is appropriate and provides protection to patients sensitized to Vespula and Polistes.
authors.affiliation: Sección de Alergia, Hospital Universitario Reina Sofía, Córdoba, Spain. carmen.moreno.sspa@juntadeandalucia.es
authors.forename: C
authors.initials: C
authors.lastname: Moreno
authors.forename: M J
authors.initials: MJ
authors.lastname: Barasona
authors.forename: P
authors.initials: P
authors.lastname: Serrano
authors.forename: J L
authors.initials: JL
authors.lastname: Justicia
authors.forename: J M
authors.initials: JM
authors.lastname: Ruz
authors.forename: F
authors.initials: F
authors.lastname: Guerra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D000818:Animals; D000918:Antibody Specificity; D002648:Child; D015331:Cohort Studies; D003888:Desensitization, Immunologic / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007299:Insect Bites and Stings / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013030:Spain; D014862:Wasp Venoms / Q000276:immunology / Q000627:therapeutic use*; D014863:Wasps / Q000276:immunology*
chemical_list: D000485:Allergens; D007074:Immunoglobulin G; D014862:Wasp Venoms; D007073:Immunoglobulin E